| NPI | 1699257881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 6582) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 2060) |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2025-03-27 |